Hertfordshire Partnership University NHS Foundation Trust

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

This means we looked for evidence that the service met people’s needs.

At our last assessment we rated this key question Good. At this assessment the rating has remained Good.

Staff provided person-centred care and gave people and carers information about care and treatment in a way that met their needs. Care was integrated to reduce the need for people to repeat their story to professionals. Staff supported people with activities outside the service, such as work, education and family relationships. The service met the needs of all people who used services, including those with a protected characteristic. Staff helped people with communication, advocacy and cultural and spiritual support. The service treated concerns and complaints seriously, investigated them and learned lessons from the result. Staff helped people plan for their future.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service made sure people were at the centre of their care and treatment choices and they decided, in partnership with them, how to respond to any relevant changes in their needs.

The service provided care based on individual needs and preferences. Staff tailored communication to meet people’s needs and preferences for example by text rather than telephone calls for some people.

We reviewed 22 care records and saw that staff tailored care to meet the individual needs of people using the service. Care plans were holistic and included social, emotional and physical needs alongside mental health needs.

Staff provided people with a copy of their care plan and a copy of the letter sent to their GP.

The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

The trust had a health inequalities plan in place that aimed to address disparities affecting people’s physical health, mental health, access to services, and outcomes. Staff had a good understanding of the health and social care needs of people who used the service.

Teams included employment specialist workers and drug and alcohol workers to meet the needs of people who used the service, and worked closely with partner agencies who provided housing, education and work support.

The trust provided case studies of people who had been able to access education and training to gain employment with the support of the employment specialist workers.

Teams completed an initial first contact form with people at assessment that was shared with other teams when signposting people on to other services so that people did not need to repeat their stories.

The service used a caseload management model so that people who used the service had a care co-ordinator allocated to them and had continuity of care.

The service provided appropriate, accurate and up-to-date information in formats that they tailored to individual needs.

The service complied with the Accessible Information Standard, a legal requirement for organisations providing NHS care. This standard ensures that people with disabilities or sensory impairments receive information and communication support in formats they can access and understand.

The trust’s website met recognised accessibility standards. Information was easy to access, with options available for users to increase text size or adjust colours and fonts to suit their individual needs.

The service ensured people could obtain information on treatments, local services, patients’ rights and how to complain. Posters were displayed in waiting areas of all team locations and included quick response (QR) codes.

The trust held forums for carers and people using services to provide feedback and share information about the service.

The service made it easy for people to share feedback and ideas or raise complaints about their care, treatment and support. They involved them in decisions about their care and told them what had changed as a result.

The service received 366 complaints in the year before inspection with 68 complaints being upheld and 100 complaints partly upheld. The service had 7 complaints referred to the ombudsman in the last year, none of which were upheld.

The trust had identified three themes from complaints and put actions in place to address them,

Delays in accessing treatment, particularly for the people waiting for ADHD assessments were one of the key themes identified. The service had addressed this through regular communication and by providing additional support for people on waiting lists. A second theme related to communication issues. In response, the service had changed the duty and handover processes to improve this. The third theme concerned inadequate care co-ordination and unmet needs. The service addressed this through audits of risk assessments and care plans, additional training for staff and exploring different ways to engage with people using the service to ensure they felt heard.

We spoke with 25 people using the service and 16 family members of people using the service, and while not everyone was aware of how to raise a complaint, information on how to raise a complaint was displayed in all locations. None of the people we spoke with had felt they needed to raise a complaint.

The service had received 252 compliments in the year before inspection. We saw examples of these and thank you cards displayed in team offices.

The service involved people who used the service in co-producing some changes to the service, including the new layout of the waiting room at Centenary House and the design of a physical health check leaflet. Focus groups were held with autistic people who used the service to help make the service more accessible and person-centred.

The service did not always make sure that everyone could access the care, support and treatment they need when they need it.

The service met the target for providing an initial assessment to people within 28 days for 95% of people referred. At the time of the inspection, 95% of people had received an assessment within 28 days. However, 4 people had waited over 28 days for an assessment.

The service had stopped accepting referrals for ADHD assessment and treatment from people who did not have complex mental health needs in February 2024 but still had ‘waiting well’ contact responsibility for 2268 people without mental health needs who were waiting for an ADHD assessment, review or treatment through the Integrated Care Board.

The service had 211 people with complex mental health needs, who therefore met the service criteria, waiting for an ADHD assessment, review or treatment. This was mainly due to medical staff shortage that had not been recruited to.

Staff reported the large number of people who needed regular contact under the ‘waiting well’ contact were one of the biggest frustrations for teams.

The service aimed for 95% of people to start treatment within 18 weeks of referral. At the time of the inspection, the service was achieving 70% of people starting treatment within 18 weeks of referral. The psychosis: prevention, assessment and treatment in Hertfordshire (PATH) were the only teams achieving the target with 97% of people starting treatment within 18 weeks. In the northwest Hertfordshire teams only 36% of people started treatment within 18 weeks, with the average waiting time of 51 weeks to start treatment. The trust had identified this as being due to medical staff vacancies which had been filled by the time of inspection. The waiting list was reviewed by multi-disciplinary teams with staff maintaining regular contact with people waiting and reviewing their risk levels.

The service had substantial waiting lists for people to access psychological therapies. The average waiting time for people waiting to start psychological treatment was 29 weeks with 10% of people waiting for over a year to start psychological treatment. The longest waiting times was 137 weeks. Staff told us they kept in regular contact with people who were on the waiting list. The trust had a plan in place to improve support to people waiting for psychological treatment including the use of support groups and digital resources.

The service actively sought and listened to information about people who are most likely to experience inequality in experience or outcomes. They tailored the care, support and treatment in response to this.

Staff were trained in equality, diversity, inclusion and human rights with 99% of staff having completed this training.

The trust had assessed itself against NHS England’s patient and carer race equality framework (PCREF). PCREF is a mandatory framework for trusts to follow to become actively anti-racist organisations by ensuring that they are responsible for co-producing and implementing concrete actions to reduce racial inequalities within their services. The trust had an action plan in place which was co-developed with people who used services, staff and stakeholders.

The provider had undertaken equality impact assessments of their policies and procedures to ensure they did not place vulnerable people or people with protected characteristics at a disadvantage.

The service supported people to plan for important life changes, so they had enough time to make informed decisions about their future.

Staff supported patients to make decisions about their care and treatment and their future and developed care plans to account for the patient’s needs, wishes and feelings. We reviewed 22 care records that included future goals and plans, such as returning to employment.

Staff ensured all relevant healthcare professionals were involved in planning the care and treatment of people with complex needs.

Care plans included safety plans, detailing the actions people should take in the event of a deterioration in their mental health, including the provision of emergency contact numbers.